Background

The current standard of treatment for locally advanced cervical cancer consists of
external radiation plus brachytherapy concurrent with weekly applications of cisplatin.
On the other hand, current evidence suggests that preoperative chemoradiation is at
least as effective as the standard treatment. Because limitations in the availability
of brachytherapy in Mexico and many other developing countries, it is of major interest
to determine whether a radical hysterectomy after external chemoradiation has superior
or at least equivalent results in terms of survival to chemoradiation and brachytherapy.
In FIGO stages IB2-IIA patients.

Patients and methods

This is a non-randomized comparison of both treatment modalities. The data of preoperative
chemoradiation modality was taken from the cisplatin arm of a randomized phase II
study we performed comparing preoperative chemoradiation with cisplatin against cisplatin/gemcitabine
(IJROBP 2005). These forty patients were paired against a cohort of 40 patients treated with external
radiation and cisplatin plus brachytherapy. In both groups, the dose of external radiation
was 50 Gy in 2 Gy fractions and cisplatin was dosed at 40 mg/m2 for six weekly applications.
Survival was analyzed with the Kaplan-Meier method and curves compared with the Log-rank
test.

Results

There were no significant differences in the clinicopathological characteristics of
the patients. Mean age was 45 years (range 24 – 70). In both groups the histologies
were squamous cell carcinoma (70%), adenocarcinoma (20%), and adenosquamous (10%).
Stage distribution according to the FIGO was as follows: IB2, 22.5%; IIA, 10%; IIB,
67.5%, in both groups. Overall, 100% of patients completed external beam, and surgery
or intracavitary brachyterapy. The majority of patients received the planned six courses
of weekly cisplatin. At median follow-up (28 months; range 2–58 months), overall survival
is 78% and 75% (p > 0.05) for the surgical and brachytherapy groups of patients.

Conclusion

The results of this non-randomized comparison suggest that these treatment modalities
are equivalent in terms of survival. A randomized study is ongoing to confirm these
results.